The Manager, Utilization Management (UM) Strategy & Implementation leads a dedicated team that supports the UM program through multiple functions with a focus on all regulatory and compliance functions.
Oversee and manage UM Operations oversight functions such as Corrective Action Plan (CAP) management, ongoing monitoring, and multiple audit activities.
Build and leverage effective cross-functional business relationships and influence action across multiple internal and external partners to support a culture of compliance.
Responsible for development and maintenance of documentation related to policy, workflow and process when applicable.
Identify process gaps and drive improvements towards UM compliance in all areas.

Bachelor’s Degree in nursing or related field is required
Master’s Degree in Business or health care field preferred
Minimum of five (5) years clinical or related healthcare industry experience is required
Prior leadership experience is required
Managed Care experience is required
Experience with analysis, data and reporting is required
Accreditation, auditing, and process improvement experience is preferred
Demonstrated change management and continuous improvement leadership skills are strongly desired

Manager, UM Operations Strategy – Implementation

Key skills